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General NPI Number Information
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NPI Number | 1255693123
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Entity Type | Organization
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Legal Business Name | HEALTHY FAMILY CLINIC LLC
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Dates
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Enumeration Date | 06/15/2012
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Last Update Date | 06/18/2012
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Provider Practice Location Address
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Address Line | 3900 W EXPRESSWAY 83
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City | MCALLEN
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State | TX
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Zip | 78501-8425
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Country | US
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Telephone | 956-682-3600
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Fax | 956-682-3609
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Provider Business Mailing Address
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Address Line | 1001 S 10TH ST STE G 787
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City | MCALLEN
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State | TX
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Zip | 78501-5049
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Country | US
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Telephone | 956-682-3600
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Fax | 956-682-3609
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Authorized Official
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Title or Position | PRESIDENT
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Name | GRACE GUERRERO
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Credential | FNP
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Telephone | 956-630-6111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2009008448
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License Number State | TX
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